Does it matter what sort of mask you wear?

Yes. Different types of mask offer different levels of protection. Surgical grade N95 respirators offer the highest level of protection, preventing the user from becoming infected with Covid-19, followed by surgical grade masks. However, these masks are costly, in limited supply, contribute to landfill waste and are uncomfortable to wear for long periods. So even countries that have required the public to wear face masks have generally suggested such masks should be reserved for health workers or those at particularly high risk.

The evidence on the protective value of single-use paper masks or reusable cloth coverings is less clear, but still suggests that face masks can contribute to reducing transmission of Covid-19. Analysis this week by the Royal Society said this included homemade cloth face masks.

The evidence on any mask use, outside of surgical masks, is still emerging: there appears to be some benefit, but the exact parameters of which masks are the best and the extent to which they protect the wearer or those around them are still being figured out. A tighter fitting around the face is probably better, but the CDC suggests any covering, including a bandana, is better than none.

R, or the 'effective reproduction number', is a way of rating a diseases ability to spread. Its the average number of people on to whom one infected person will pass the virus. For an R of anything above 1, an epidemic will grow exponentially. Anything below 1 and an outbreak will fizzle out eventually.

At the start of the coronavirus pandemic, the estimated R for coronavirus was between 2 and 3 higher than the value for seasonal flu, but lower than for measles. That means each person would pass it on to between two and three people on average, before either recovering or dying, and each of those people would pass it on to a further two to three others, causing the total number of cases to snowball over time.

The reproduction number is not fixed, though. It depends on the biology of the virus; people's behaviour, such as social distancing;and a populations immunity.

Hannah DevlinScience correspondent

One US study investigated which household materials best removed particles of 0.3-1.0 microns in diameter, the typical size of viruses and bacteria, and concluded that good options include vacuum cleaner bags, heavyweight quilters cotton or multiple layers of material. Scarves and bandana material were less effective, but still captured a fraction of particles.

Before putting on a mask, clean your hands well with soap and water. Cover the mouth and nose with your mask and make sure there are no gaps between your face and the mask. Avoid touching the mask while using it and, if you do, wash your hands. Replace the mask when it is damp. To remove your mask, take it off using the elastic tags, without touching the front and discard immediately into a closed bin or, if the mask is reusable, directly into the washing machine.

They should be washed after each use. The US Center for Disease Control suggests routinely.

Many commercially available masks are made from layers of plastics and are designed to be single-use. According to an analysis by scientists at University College London, if every person in the UK used one single-use mask each day for a year, an extra 66,000 tonnes of contaminated plastic waste would be created. The use of reusable masks by the general population would significantly reduce plastic waste and the climate change impact of any policy requirements for the wearing of face masks, according to the UCL team, led by Prof Mark Miodownik. They say that according to the best evidence, reusable masks perform most of the tasks of single-use masks without the associated waste stream.

See more here:

What kind of face mask will best protect you against coronavirus? - The Guardian

Researcher Francois Balloux of the University College London Genetics Institute and his colleagues in the United Kingdom pulled viral sequences from a giant global database that scientists around the world are using to share data.

They looked at samples taken at different times and from different places, and said they indicate that the virus began infecting people at the end of 2019.

"Our results are in line with previous estimates and point to all sequences sharing a common ancestor towards the end of 2019, supporting this as the period when SARS-CoV-2 jumped into its human host," the team wrote in a report, published in the journal Infection, Genetics and Evolution.

Balloux told CNN his team is "really, really, really confident" about when the host jumped.

They also found genetic evidence that supports suspicions the virus was infecting people in Europe, the United States and elsewhere weeks or even months before the first official cases were reported in January and February.

One US community is checking to see whether there were cases there that went undiagnosed in 2019.

In Chicago, the Cook County Medical Examiner's Office said it will review deaths involving heart attacks and pneumonia for indications of Covid-19 as far back as November, Cook County spokesperson Natalia Derevyanny told CNN.

The first known coronavirus death in the county was March 16.

The office will look at viral pneumonia cases along with heart attacks caused by arteries being blocked (arterial thrombosis), as opposed to cases brought on by heart failure.

"The goal is to see if this virus was present before we knew of it," Derevyanny said.

While Derevyanny called the decision to look back to November an arbitrary timeframe, if a positive case is discovered it will prompt the office to look back even further.

The investigation may include additional testing of preserved tissue samples, Derevyanny said.

Cuomo: It comes down to how much you value life

New York Gov. Andrew Cuomo on Tuesday said debates on how soon states should ease social distancing restrictions come down to the value of human life -- and that policymakers are avoiding saying so explicitly.

"The fundamental question, which we're not articulating, is how much is a human life worth?" Cuomo said at a news conference.

"The faster we reopen, the lower the economic cost. But, the higher the human cost, because (of) more lives lost," Cuomo said in a news conference. "That ... is the decision we are really making."

But easing restrictions now may come with a heavy price.

"It's the balance of something that's a very difficult choice," Dr. Anthony Fauci, the country's leading infectious disease expert, told CNN Monday night. "How many deaths and how much suffering are you willing to accept to get back to what you want to be some form of normality, sooner rather than later?"

At least 42 states will have eased restrictions by Sunday, ranging from simply opening state parks to allowing some businesses to restart. That includes California -- the first state to implement a sweeping stay-at-home order -- where some stores will be allowed to reopen this week.

So far, the US has recorded more than 1,200,000 infections and at least 71,043 deaths.

Poll: Majority prioritizes preventing illness over economy

A majority of Americans who answered a Monmouth University poll, meanwhile, indicated they prioritize preventing illnesses over long-term economic concerns.

In the poll, conducted Thursday though Monday, adults were asked which should be the more important factor in deciding whether to lift outbreak restrictions -- ensuring as few people as possible get sick from the coronavirus, or ensuring the economy doesn't enter a deep and lengthy downturn.

About 56% answered the former; 33% said the latter; 9% said both equally. The poll of 808 adults in the United States has a margin of error of +/- 3.5 percentage points, Monmouth said Tuesday.

More vaccine candidates tested in the US

Researchers continue to race for a potential coronavirus vaccine -- and another group of candidates is being tested on people in the United States.

US pharmaceutical giant Pfizer and German biotechnology company BioNTech have begun testing four coronavirus vaccine candidates in humans in New York and Maryland, the companies said Tuesday.

The first stage of the US trial will enroll up to 360 healthy adults, starting with ages 18 to 55 and eventually including ages 65 to 85, the companies said.

These companies aren't the first with a vaccine program this far along.

The World Health Organization says 108 potential Covid-19 vaccines are in development around the world -- up from 102 on April 30. Eight of the potential vaccine programs have been approved for clinical trials, WHO says.

How governors are moving forward

California was one of the states where crowds gathered over the weekend as thousands of protesters descended on the state's Capitol and an Orange County beach to protest social distancing orders.

The governor on Monday announced retail shops in the state -- including clothing stores, florists and bookstores -- can begin to reopen Friday, after health officials said the state was meeting important metrics including sufficient test and tracing capacity.

Los Angeles Mayor Eric Garcetti said he didn't think his city would reopen this week, saying Monday that despite the governor's announcement, different parts of the state may see different timelines for reopening.

In Michigan, Gov. Gretchen Whitmer said the lockdown will continue "until at least May 15," warning that reopening the state too soon could lead to a second shutdown.

Reeves' plan also allows dining service in restaurants, as long as the institutions follow guidelines provided by the state, including a mandatory deep cleaning.

"I don't want to wait if there are steps that we believe we can safely take now to ease the burden on Mississippians fighting this virus," he said.

Protests against masks

CNN's Frederick Pleitgen, Jacqueline Howard, Elizabeth Cohen and Jennifer Henderson contributed to this report.

View post:

New evidence indicates coronavirus was infecting people in Europe and the US before the first official cases were reported - CNN

Among the most important unanswered questions about Covid-19 is this: What role do children play in keeping the pandemic going?

Fewer children seem to get infected by the coronavirus than adults, and most of those who do have mild symptoms, if any. But do they pass the virus on to adults and continue the chain of transmission?

The answer is key to deciding whether and when to reopen schools, a step that President Trump urged states to consider before the summer.

Two new studies offer compelling evidence that children can transmit the virus. Neither proved it, but the evidence was strong enough to suggest that schools should be kept closed for now, many epidemiologists who were not involved in the research said.

Many other countries, including Israel, Finland, France, Germany, the Netherlands and the United Kingdom have all either reopened schools or are considering doing so in the next few weeks.

In some of those countries, the rate of community transmission is low enough to take the risk. But in others, including the United States, reopening schools may nudge the epidemics reproduction number the number of new infections estimated to stem from a single case, commonly referred to as R0 to dangerous levels, epidemiologists warned after reviewing the results from the new studies.

In one study, published last week in the journal Science, a team analyzed data from two cities in China Wuhan, where the virus first emerged, and Shanghai and found that children were about a third as susceptible to coronavirus infection as adults were. But when schools were open, they found, children had about three times as many contacts as adults, and three times as many opportunities to become infected, essentially evening out their risk.

Based on their data, the researchers estimated that closing schools is not enough on its own to stop an outbreak, but it can reduce the surge by about 40 to 60 percent and slow the epidemics course.

My simulation shows that yes, if you reopen the schools, youll see a big increase in the reproduction number, which is exactly what you dont want, said Marco Ajelli, a mathematical epidemiologist who did the work while at the Bruno Kessler Foundation in Trento, Italy.

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The second study, by a group of German researchers, was more straightforward. The team tested children and adults and found that children who test positive harbor just as much virus as adults do sometimes more and so, presumably, are just as infectious.

Are any of these studies definitive? The answer is No, of course not, said Jeffrey Shaman, an epidemiologist at Columbia University who was not involved in either study. But, he said, to open schools because of some uninvestigated notion that children arent really involved in this, that would be a very foolish thing.

The German study was led by Christian Drosten, a virologist who has ascended to something like celebrity status in recent months for his candid and clear commentary on the pandemic. Dr. Drosten leads a large virology lab in Berlin that has tested about 60,000 people for the coronavirus. Consistent with other studies, he and his colleagues found many more infected adults than children.

The team also analyzed a group of 47 infected children between ages 1 and 11. Fifteen of them had an underlying condition or were hospitalized, but the remaining were mostly free of symptoms. The children who were asymptomatic had viral loads that were just as high or higher than the symptomatic children or adults.

In this cloud of children, there are these few children that have a virus concentration that is sky-high, Dr. Drosten said.

He noted that there is a significant body of work suggesting that a persons viral load tracks closely with their infectiousness. So Im a bit reluctant to happily recommend to politicians that we can now reopen day cares and schools.

Dr. Drosten said he posted his study on his labs website ahead of its peer review because of the ongoing discussion about schools in Germany.

Many statisticians contacted him via Twitter suggesting one or another more sophisticated analysis. His team applied the suggestions, Dr. Drosten said, and even invited one of the statisticians to collaborate.

But the message of the paper is really unchanged by any type of more sophisticated statistical analysis, he said. For the United States to even consider reopening schools, he said, I think its way too early.

In the China study, the researchers created a contact matrix of 636 people in Wuhan and 557 people in Shanghai. They called each of these people and asked them to recall everyone theyd had contact with the day before the call.

They defined a contact as either an in-person conversation involving three or more words or physical touch such as a handshake, and asked for the age of each contact as well as the relationship to the survey participant.

Comparing the lockdown with a baseline survey from Shanghai in 2018, they found that the number of contacts during the lockdown decreased by about a factor of seven in Wuhan and eight in Shanghai.

There was a huge decrease in the number of contacts, Dr. Ajelli said. In both of those places, that explains why the epidemic came under control.

The researchers also had access to a rich data set from Hunan provinces Center for Disease Control and Prevention. Officials in the province traced 7,000 contacts of 137 confirmed cases, observed them over 14 days and tested them for coronavirus infection. They had information not just for people who became ill, but for those who became infected and remained asymptomatic, and for anyone who remained virus-free.

Data from hospitals or from households tend to focus only on people who are symptomatic or severely ill, Dr. Ajelli noted. This kind of data is better.

The researchers stratified the data from these contacts by age and found that children between the ages of 0 and 14 years are about a third less susceptible to coronavirus infection than those ages 15 to 64, and adults 65 or older are more susceptible by about 50 percent.

They also estimated that closing schools can lower the reproduction number again, the estimate of the number of infections tied to a single case by about 0.3; an epidemic starts to grow exponentially once this metric tops 1.

In many parts of the United States, the number is already hovering around 0.8, Dr. Ajelli said. If youre so close to the threshold, an addition of 0.3 can be devastating.

However, some other experts noted that keeping schools closed indefinitely is not just impractical, but may do lasting harm to children.

Jennifer Nuzzo, an epidemiologist at Johns Hopkins Universitys Bloomberg School of Public Health, said the decision to reopen schools cannot be made based solely on trying to prevent transmission.

I think we have to take a holistic view of the impact of school closures on kids and our families, Dr. Nuzzo said. I do worry at some point, the accumulated harms from the measures may exceed the harm to the kids from the virus.

E-learning approaches may temporarily provide children with a routine, but any parent will tell you its not really learning, she said. Children are known to backslide during the summer months, and adding several more months to that might permanently hurt them, and particularly those who are already struggling.

Im not saying we need to absolutely rip off the Band-aid and reopen schools tomorrow, she said, but we have to consider these other endpoints.

Dr. Nuzzo also pointed to a study in the Netherlands, conducted by the Dutch government, which concluded that patients under 20 years play a much smaller role in the spread than adults and the elderly.

But other experts said that study was not well designed because it looked at household transmission. Unless the scientists deliberately tested everyone, they would have noticed and tested only more severe infections which tend to be among adults, said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.

Assumptions that children are not involved in the epidemiology, because they do not have severe illness, are exactly the kind of assumption that you really, really need to question in the face of a pandemic, Dr. Hanage said. Because if its wrong, it has really pretty disastrous consequences.

The experts all agreed on one thing: that governments should hold active discussions on what reopening schools looks like. Students could be scheduled to come to school on different days to reduce the number of people in the building at one time, for example; desks could be placed six feet apart; and schools could avoid having students gather in large groups.

Teachers with underlying health conditions or of advanced age should be allowed to opt out and given alternative jobs outside the classroom, if possible, Dr. Nuzzo said, and children with underlying conditions should continue to learn from home.

The leaders of the two new studies, Dr. Drosten and Dr. Ajelli, were both more circumspect, saying their role is merely to provide the data that governments can use to make policies.

Im somehow the bringer of the bad news but I cant change the news, Dr. Drosten said. Its in the data.

Here is the original post:

New Studies Add to Evidence that Children May Transmit the Coronavirus - The New York Times

Ventilators have become the single most important piece of medical equipment for critically ill coronavirus patients whose damaged lungs prevent them from getting enough oxygen to vital organs. The machines work by forcing air deep into the lungs, dislodging the fluid and accumulated pus that interfere with the exchange of oxygen, a process orchestrated by tiny air sacs known as alveoli.

Lungs are complex organs that deliver oxygen to the bloodstream and keep organs functioning.

Human lungs are spongy vessels made up of millions of microscopic, balloon-shaped air sacs called alveoli, the workhorse of the respiratory system where the exchange of gases takes place.

A single alveolus, no bigger than the width of a human hair, is ringed by a mesh of tiny capillaries that transport oxygen to the bloodstream.

A single alveolus, no bigger than the width of a human hair, is ringed by a mesh of tiny capillaries that transport oxygen to the bloodstream.

A single alveolus, no bigger than the width of a human hair, is ringed by a mesh of tiny capillaries that transport oxygen to the bloodstream.

Ventilators are not a cure for Covid-19 patients, but mechanical breathing assistance can keep patients alive while they battle the infection.

Critical care ventilators are more than just air pumps. They are finely tuned machines with software that must be constantly adjusted by skilled medical workers to ensure that patients receive the right combination of oxygen level, pressure, breath volume and breathing rate.

Non-coronavirus patients on ventilators have about a 50 percent survival rate. The mortality rate for coronavirus patients on ventilators is not yet clear in part because, with no proven method of treatment for the virus, coronavirus patients are often being kept on these machines for weeks in order to keep them breathing long enough to give their lungs a chance to heal.

Exhaled air is filtered for viral particles

Air supplied to the patient

contains 21-100% oxygen

Air supplied to the patient

contains 21-100% oxygen

Exhaled air

is filtered

for viral particles

Intubation is fraught. Patients must be heavily sedated to allow doctors to insert a breathing tube into the lungs and to prevent them from waking up and pulling out the tubes. Because too much air pressure can damage the lungs, intubated patients must be constantly monitored.

Fears of a ventilator shortage in New York and the poor prognosis for intubated patients have helped spur innovations for sustaining patients without relying on critical care ventilators.

Health care providers have embraced a maneuver that has long been used for ventilated patients periodically turning them on their stomach to increase lung capacity. Proning, as its called, opens up areas of the lungs that are normally compressed by the weight of the heart when lying on ones back. Doctors are currently studying whether using proning for some patients in respiratory distress can allow them to recover without being placed on ventilators.

Flipping over patients in acute respiratory distress, doctors have discovered, can markedly increase oxygenation. The process can be labor-intensive, however, requiring staff to turn over patients several times a day.

Medical workers have increasingly turned to CPAP and BiPAP machines, inexpensive air pumps used by millions of Americans with sleep apnea, chronic obstructive pulmonary disease and other breathing disorders. Hospitals have been repurposing unused machines and using them both with or without intubation to send pressurized air into the lungs of coronavirus patients.

Soft and transparent plastic helmet

holds positive pressure inside

Room oxygen

supply option

Soft collar

seals helmet at the neck

Plastic helmet

holds positive

pressure inside

Room oxygen

supply option

To reduce the risk of infection for hospital workers, doctors have also been fitting patients with jury-rigged helmets that deliver oxygen via CPAP machines while filtering out exhaled viral particles. The helmets were pioneered by Italian doctors forced to improvise because of a shortage of intensive care ventilators.

Link:

In the Fight to Treat Coronavirus, Your Lungs Are a Battlefield - The New York Times

As the Defense Department negotiates its way through the coronavirus pandemic and its fallout, military entrance processing stations are working with new guidance when it comes to bringing COVID-19 survivors into the services.

A past COVID-19 diagnosis is a no-go for processing, according to a recently released MEPCOM memo circulating on Twitter.

During the medical history interview or examination, a history of COVID-19, confirmed by either a laboratory test or a clinician diagnosis, is permanently disqualifying ... the memo reads.

The memo is authentic, Pentagon spokeswoman Jessica Maxwell confirmed to Military Times.

Specifically, it lays out guidelines for MEPS staff to deal with potential, as well as confirmed, coronavirus cases. That starts with screening at all MEPS, which includes taking a temperature and answering questions about symptoms and potential contact.

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If an applicant fails screening, according to the memo, they wont be tested, but they can return in 14 days if theyre symptom-free. Anyone who has been diagnosed with COVID-19 will have to wait until 28 days after diagnosis to report to MEPS.

Upon return, a diagnosis will be marked as permanently disqualifying for accession. Recruits can apply for waivers for all permanently disqualifying conditions, including surviving COVID-19. However, without any further guidance for exceptions dealing with COVID-19, a review authority would have no justification to grant a waiver.

Maxwell declined to explain why a coronavirus diagnosis would be permanently disqualifying, compared to other viral, non-chronic illnesses that do not preclude military service.

However, given the limited research on COVID-19, there are likely a few factors that military medical professionals are trying to hash out when it comes to recruiting survivors: Whether respiratory damage from the virus is long-lasting or permanent, and whether that can be assessed; the likelihood of recurring flare-ups, even if someone has had two consecutive negative tests; and the possibility that one bout of COVID-19 might not provide full immunity for the future, and could potentially leave someone at a higher risk to contract it again, perhaps with worse complications.

The move comes as the services prepare for a surge of post-graduation recruits during the summer and fall high season.

In recent weeks, new trainees have been 100-percent tested for COVID-19 before starting training. So far, clusters have been discovered at Fort Jackson, South Carolina, and Marine Corps Recruit Depot San Diego, the Army and Marine Corps biggest initial entry training installations.

Excerpt from:

Coronavirus survivors banned from joining the military - Military Times

"You may," responds a Hong Kong official, who is still wearing his mask.

Moments later, Rana and I exchange rings, sign government documents, and share a brief kiss. Amid the uncertainty of the coronavirus pandemic, Rana and I have just gotten married.

On the other side of the planet, our families and friends in the US, Lebanon and elsewhere watch the little civil ceremony in Hong Kong streamed live on Instagram, sprinkling the video with hearts and emojis and other social media expressions of happiness.

Before leaving the wedding registry, we put on his and hers surgical masks adorned with the titles "Mr." and "Mrs."

This was not what we expected, when I first asked her to marry me on a freezing night in New York City last December.

At the time, we were both jet-lagged after the long flight from Hong Kong, where we live and work. We were also deliriously happy, posing in front of a glowing fountain alongside my sister and brother-in-law, who conspired with me to take surprise photos of the occasion.

Basking in that happy moment, we had little clue that a deadly new strain of pneumonia had just been discovered in a city called Wuhan in China -- and the next four and a half months of our lives became our Engagement with Coronavirus.

Neither of us are strangers to crisis.

Rana grew up in Beirut in a civil war. At a young age, she suffered the loss of her father, one of many tragic victims of that conflict.

While my childhood was much more comfortable, 20 years of reporting overseas exposed me to the grim realities of war, natural disaster and political instability.

Still, neither of us had ever been confronted by a modern-day plague of global proportions.

The wake-up call came at the end of January, when the Hong Kong administration canceled schools, shut down public recreation centers and issued work-from-home orders to civil servants. The coronavirus outbreak in Wuhan had spread across China, and the first cases had been detected in the semi-autonomous cities of Hong Kong and Macau.

Hong Kongers didn't mess around. Immediately, the whole city started wearing masks.

We did too, when we went to the Births, Deaths and Marriages Registrations Office in early February to apply for a date to get married.

Friends and family back home called to express concern about our health. But they spoke about the epidemic as if it was some distant threat, an "Asian" problem that would never reach their shores.

As Rana became more and more worried, I remained naively optimistic -- until a reporting assignment in South Korea at the end of February.

At that stage, South Korea had the most confirmed coronavirus cases outside mainland China. In early March, thousands of Koreans were testing positive on a daily basis. Governments increasingly imposed international flight restrictions. Seemingly overnight, my hotel in Seoul became eerily empty.

On March 10, the only way to get from South Korea back home to Hong Kong was to fly absurdly long distances via London. On the flight from South Korea, CNN cameraman Tom Booth and I were shocked to see British Airways crews operating without any protection. No one checked our temperature during the layover at London's Heathrow Airport. Britain apparently behaved as if this deadly disease wasn't happening.

Upon arrival in Hong Kong, health authorities put me on two-week mandatory medical surveillance. I was to check my temperature twice daily and report immediately if I came down with symptoms. Though authorities advised against it, Rana insisted on staying by my side throughout the 14 days. Fortunately, neither of us got sick.

Making the best of it

Then, throughout March, Covid-19 spread like wildfire across the Middle East, Europe and North America. Suddenly, Rana and I were far more worried about our parents in the US and Lebanon, than we were for ourselves in Hong Kong.

For two people who have lived almost all of our adult lives overseas, a sickening realization set in -- we could no longer count on jumping on a plane to fly home to our loved ones in the event of an emergency.

Yet amid the anxiety and fear, a silver lining emerged.

In this pandemic, we had each other. Social isolation meant a pause in business travel and long work deployments.

With our little rescue cat, our small family settled in for weeks of working from home in pajamas followed by cozy home-cooked dinners.

The coronavirus forced us to stop and count our blessings. The entire world has been taught a giant lesson in humility, a reminder that we are subject to forces and events that we cannot control. Nothing -- neither our health, the roof over our heads, nor the food on our table -- can be taken for granted.

At the same time, life must go on.

"After all, your grandparents got married during World War II," my mom pointed out.

She is very right. My grandparents, two refugees from the civil war in Russia, started a family amid the horrors of Nazi-occupied France.

Compare that to me and Rana, who spent much of our engagement on the couch watching "Tiger King" (among other things).

So far, we have had it so easy. A week before the wedding, however, disaster struck. Rana's 84-year old grandmother suffered a stroke. She was taken to intensive care in Beirut and had brain surgery.

There was nothing we could do. Even if there was some way to fly to Lebanon, Rana would not dare exposing her family if she picked up an illness on the plane.

Thankfully, Rana's teta stabilized after the operation. She's a tough lady.

Finally, our wedding day arrived in May. We wore surgical masks with "bride" and "groom" written on them in marker to the registry.

The city's coronavirus guidelines allow up to 20 guests at a wedding. We had eight.

There is no time for vows to be exchanged during the 15-minute civil ceremony -- although in some ways, we didn't need them.

After our engagement with coronavirus, we know we will be there for each other, no matter what the future may bring.

See more here:

Engaged in December and married by May, coronavirus shaped our relationship ... and our wedding - CNN

LONDON Black people in England and Wales are twice as likely to die from the coronavirus as white people, even accounting for differences in class and in some underlying health measures, according to official figures released on Thursday, laying bare an extraordinary gap in the toll of the coronavirus.

The analysis, conducted by Britains Office of National Statistics, found that longstanding differences in wealth, education, living arrangements and self-reported health could explain a portion of the outsized impact of the virus on racial and ethnic minorities.

But not all of it. The number of black and South Asian people working in public-facing jobs and living with conditions that increase vulnerability to the coronavirus, like obesity, hypertension and diabetes, may account for other parts of the elevated risk, researchers said.

The underlying health and social disparities that drive inequality in health and life expectancy have been there all along, and this virus has just laid them bare, said Dr. Riyaz Patel, an associate professor of cardiology at University College London. This pandemic has not been the great leveler. Its been the great magnifier, as it were.

More than 30,000 people in Britain have died from the coronavirus, among the worst death tolls in Europe.

As the outsized toll of the virus on black and South Asian people has emerged in recent weeks, the government of Prime Minister Boris Johnson, a Conservative, has been forced to respond.

Matt Hancock, the health secretary, said on Monday: We recognize that there has been a disproportionately high number of people from black and ethnic minority backgrounds who have passed away, especially among care workers and those in the N.H.S.

Among the major unanswered questions is whether people from racial and ethnic minority groups are catching the virus at higher rates or, once they catch it, are suffering more serious effects, said Keith Neal, an emeritus professor of the epidemiology of infectious diseases at the University of Nottingham.

If theyre catching it twice as often, thats a different answer to theyre dying twice as often, Professor Neal said.

The analysis from the Office of National Statistics went beyond previous studies in Britain in examining the fate not only of hospital patients, but also of people in nursing homes and elsewhere who died from the virus.

After accounting for limited class and health data, people of Bangladeshi and Pakistani ethnicities were nearly twice as likely to die from the coronavirus as white people.

People of Indian and mixed ethnicities also had an elevated risk of death, the analysis found. The only group with a lower risk of death than their white counterparts, accounting for socio-economic differences, was Chinese women.

The researchers accounted for a range of factors that could be associated with peoples risk from the virus. Among them were crowding in households, urban-rural divides, income and education.

Nearly a third of Bangladeshi households, a sixth of Pakistani households and an eighth of black households experienced overcrowding from 2014 to 2017, a risk factor for spreading the coronavirus. Only 2 percent of white British households experienced the same, according to a study of the English Housing Survey.

Black people and ethnic minorities are also more likely to live in cities, where the virus arrived first in Britain and spread much more quickly.

The researchers also adjusted for a rough measure of self-reported health from the 2011 census and the presence of disability. That helped account for pre-existing health disparities, analysts said, but not necessarily the higher prevalence among minorities of specific conditions that raise the risk from the virus.

Without accounting for class or health differences, black people were four times as likely to die from the coronavirus as white people in England and Wales, the Office of National Statistics found.

Dr. Patel questioned whether successive British governments had done enough over the long term to improve the health of vulnerable groups and help them withstand a pandemic.

Health inequality has increased over the last decade or more, rather than decreased, he said. He pointed to the February report about health inequities showing that, for part of the period from 2010 to 2020, life expectancy actually fell in the most deprived communities outside London for women and in some regions for men.

Some lawmakers demanded action in response to the analysis on Thursday.

Appalling, said David Lammy, a Labour lawmaker. It is urgent the causes of this disproportionality are investigated. Action must be taken to protect black men and women as well as people from all backgrounds from the virus.

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Coronavirus Killing Black Britons at Twice the Rate of Whites - The New York Times

The World Health Organization lists the most common symptoms of Covid-19 as fever, tiredness and a dry cough. Others include a runny nose, sore throat, nasal congestion, pain, diarrhoea and the loss of sense of taste and/or smell. But there are also other more unusual symptoms that patients have presented.

Patients in several countries have reported rashes on their toes, resembling chilblains, in many cases unaccompanied by any of the usual symptoms of the virus. The condition has been dubbed Covid toe. The rashes can take the form of red or purple lesions and, despite the name, can be found on the side or sole of the foot, or even on hands and fingers. The European Journal of Pediatric Dermatology reported an epidemic of cases among children and adolescents in Italy. It said that unlike other rashes associated with coronavirus, it had not been previously observed.

Conjunctivitis has been a rare symptom in cases of Covid-19, with viral particles being found in tears. In the UK, the Royal College of Ophthalmologists and College of Optometrists says: It is recognised that any upper respiratory tract infection may result in viral conjunctivitis as a secondary complication, and this is also the case with Covid-19. However, it is unlikely that a person would present with viral conjunctivitis secondary to Covid-19 without other symptoms of fever or a continuous cough as conjunctivitis seems to be a late feature where is has occurred.

A peer-reviewed Spanish study, published in the British Journal of Dermatology last week, found that 6% of the 375 coronavirus cases examined involved necrosis, the death of body tissue due to a lack of blood supply, or livedo, discolouration of the skin. The skin can become mottled and have purple or red patchy areas, which may appear in a lace-like pattern. In the study, it was generally found in older patients with more severe cases of Covid-19. However, this was not consistent across the board and necrosis was also found in some people with coronavirus who did not require hospitalisation.

A study of 214 patients in China, published in Jama Neurology last month, found that just over a third (36.4%) had experienced neurological symptoms such as dizziness or headaches, increasing to 45.5% in those with severe coronavirus infections. Commenting on the research, Prof Ian Jones, professor of virology at the University of Reading, said: It happens, but is generally not what coronaviruses do. At the moment neurological complications might best be considered a consequence of Covid-19 disease severity rather than a distinct new concern.

Some patients have complained about a tingling, fizzing or even burning sensation. Dr Waleed Javaid, the director of infection prevention and control at Mount Sinai hospital in New York, told Today.com it was likely the patients immune response to Covid-19 rather than the virus itself was causing such sensations. He said: Theres a widespread immune response that is happening. Our immune cells get activated so a lot of chemicals get released throughout our body and that can present or feel like theres some fizzing. When our immune response is acting up, people can feel different sensations I have heard of similar experiences in the past with other illnesses.

This article was amended on 8 May 2020 to correct a reference to livedo that should have said necrosis.

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Rashes, headaches, tingling: the less common coronavirus symptoms that patients have - The Guardian

Noraneko, a Southeast Portland ramen shop with ties to one of the Portland food scenes important early Japanese restaurants, does not plan to reopen after the coronavirus pandemic, co-owner Gabe Rosen wrote in an email to The Oregonian/OregonLive.com.

In the best of times (which was usually!), Noraneko was a tough spot to operate, Rosen wrote. We were an entirely (noodles excepted) from-scratch restaurant that paid staff well and tried to do everything that we could to make a great experience for guests, be authentic to ourselves and delicious, and try and stay relatively affordable.

"Every year this got more and more difficult.

Rosen says he has kept busy winding down Noraneko and decompressing after 13 years in the restaurant business.

Noraneko, Japanese for alleycat, opened on Southeast Water Avenue in 2014, forming a mini Portland ramen row with the nearby Boke Bowl. It was the second restaurant from Rosen and partner Kina Voelz, whos earlier izakaya, Biwa, helped teach Portland what good ramen could be. Biwa closed in 2018.

In a 2015 review written just after a week-long ramen eating adventure in Tokyo, I praised the boiled gyoza, fresh-squeezed juices and toppings -- its easy to forget how hard it was to find a properly boiled ramen egg back then -- while guessing it would slot in next to places like Mirakutei as a good every day bowl of ramen.

And thats just what happened. Even as Portland got swept up in a mini wave of real-deal Tokyo ramen imports such as Kizuki (now Kukai), Marukin and Afuri, Noraneko often beckoned to bike riders heading home on the Hawthorne Bridge, its neon and shadowy locale offering the closest thing to a Bladerunner-ish noodle shop in Portland. Ill miss those boiled gyoza.

-- Michael Russell, mrussell@oregonian.com, @tdmrussell

Subscribe to Oregonian/OregonLive newsletters and podcasts for the latest news and top stories.

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Noraneko, noted Southeast Portland ramen shop, will not reopen after coronavirus crisis - OregonLive

The text messages to the Chinese activist streamed in from ordinary Wuhan residents, making the same extraordinary request: Help me sue the Chinese government. One said his mother had died from the coronavirus after being turned away from multiple hospitals. Another said her father-in-law had died in quarantine.

But after weeks of back-and-forth planning, the seven residents who had reached out to Yang Zhanqing, the activist, suddenly changed their minds in late April, or stopped responding. At least two of them had been threatened by the police, Mr. Yang said.

The Chinese authorities are clamping down as grieving relatives, along with activists, press the ruling Communist Party for an accounting of what went wrong in Wuhan, the city where the coronavirus killed thousands before spreading to the rest of China and the world.

Lawyers have been warned not to file suit against the government. The police have interrogated bereaved family members who connected with others like them online. Volunteers who tried to thwart the states censorship apparatus by preserving reports about the outbreak have disappeared.

They are worried that if people defend their rights, the international community will know what the real situation is like in Wuhan and the true experiences of the families there, said Mr. Yang, who is living in New York, where he fled after he was briefly detained for his work in China.

The crackdown underscores the partys fear that any attempt to dwell on what happened in Wuhan, or to hold officials responsible, will undermine the states narrative that only Chinas authoritarian system saved the country from a devastating health crisis.

To inspire patriotic fervor, state propaganda has portrayed the dead not as victims, but as martyrs. Censors have deleted Chinese news reports that exposed officials early efforts to hide the severity of the outbreak.

The party has long been wary of public grief and the dangers it could pose to its rule.

In 2008, after an earthquake in Sichuan Province killed at least 69,000 people, Chinese officials offered hush money to parents whose children died. Following a deadly train crash in the city of Wenzhou in 2011, officials prevented relatives from visiting the site. Each June, the authorities in Beijing silence family members of protesters who were killed in the 1989 crackdown on the Tiananmen Square pro-democracy movement.

Now, some say the government is imposing the same kind of collective amnesia around the outbreak.

Three volunteers involved in Terminus2049, an online project that archived censored news articles about the outbreak, went missing in Beijing last month and are presumed to have been detained.

I had previously told him: You guys probably face some risk doing this project. But I didnt know how much, said Chen Kun, whose brother, Chen Mei, is one of the volunteers who disappeared.

I had said that maybe he would be summoned by the police for a talk, and they would ask him to take down the site, he said. I didnt think it would be this serious.

Mr. Chen said he had no information about his brothers disappearance. But he had spoken to the relatives of one of the other missing volunteers, Cai Wei, who said that Mr. Cai and his girlfriend had been detained and accused of picking quarrels and provoking trouble, a vague charge that the government often uses against dissidents.

Reached by telephone on Tuesday, an employee at a police station in the Beijing district where Chen Mei lives said he was unclear about the case. The groups site on GitHub, a platform popular with coders, is now blocked in China.

Volunteers for similar online projects have also been questioned by the authorities in recent days. In blog posts and private messages, members of such communities have warned each other to scrub their computers. The organizers of another GitHub project, 2019ncovmemory, which also republished censored material about the outbreak, have set their archive to private.

To the authorities, it seems no public criticism can be left unchecked. The police in Hubei, the province that includes Wuhan and was hardest hit by the outbreak, arrested a woman last month for organizing a protest against high vegetable prices. An official at a Wuhan hospital was removed from his post after he criticized the use of traditional Chinese medicine to treat coronavirus patients, which the authorities had promoted.

The crackdown has been most galling to people mourning family members. They say they are being harassed and subjected to close monitoring as they try to reckon with their losses.

The coronavirus killed nearly 4,000 people in Wuhan, according to Chinas official figures. Some residents believe the true toll is much higher. The government fired two high-ranking local officials, but that is not enough for many grieving relatives, who say they want fair compensation for their losses and harsher punishment for officials.

Zhang Hai is certain that his father, who died in February, was infected with the coronavirus at a Wuhan hospital. He says he still supports the party but thinks local officials should be held responsible for initially hiding the fact that the virus could spread among humans. Had he known the risk, he said, he would not have sent his father to the hospital for treatment.

Mr. Zhang said several Chinese reporters who had interviewed him about his demands later told him that their editors had pulled the articles before publication. He posted calls online to set up a monument in honor of the victims of the epidemic in Wuhan, but censors quickly scrubbed the messages. Officials have pressed him to bury his fathers ashes, but he has so far refused; he says they have insisted on assigning him minders, who he believes would be there to ensure that he caused no trouble.

They spend so much time trying to control us, Mr. Zhang said. Why cant they use this energy to address our concerns instead?

In March, the police visited a Wuhan resident who had started a chat group of more than 100 people who lost relatives to the virus, according to two members of the group, one of whom shared a video of the encounter. The group was ordered to disband.

Mr. Yang, the activist in New York, said at least two of the seven Wuhan residents who had contacted him about taking legal measures against the government dropped the idea after being threatened by the police.

Even if the other plaintiffs were willing to move forward, they might have trouble finding lawyers. After Mr. Yang and a group of human rights lawyers in China issued an open call in March for people who wanted to sue the government, several lawyers around the country received verbal warnings from judicial officials, Mr. Yang said.

The officials told them not to write open letters or create disturbances by filing claims for compensation, according to Chen Jiangang, a member of the group. Mr. Chen, who fled to the United States last year, said he had heard from several lawyers who were warned.

If anyone dares to make a request and the government fails to meet it, they immediately are seen as a threat to national security, Mr. Chen said. It doesnt matter whether youre a lawyer or a victim, its like youre imprisoned.

Some aggrieved residents have pressed ahead despite the government clampdown. Last month, Tan Jun, a civil servant in Yichang, a city in Hubei Province, became the first person to publicly attempt to sue the authorities over their response to the outbreak.

Mr. Tan, who works in the citys parks department, accused the provincial government of concealing and covering up the true nature of the virus, leading people to ignore the viruss danger, relax their vigilance and neglect their self-protection, according to a copy of the complaint shared online. He pointed to officials decision to host a banquet for 40,000 families in Wuhan in early January, even as the virus was spreading.

He urged the government to issue an apology on the front page of the Hubei Daily, a local newspaper.

In a brief phone call, Mr. Tan confirmed that he had submitted a complaint to the Intermediate Peoples Court in Wuhan, but he declined to be interviewed because he is a civil servant.

With Chinas judiciary tightly controlled by the central government, it was unclear whether Mr. Tan would get his day in court. Articles about Mr. Tan have been censored on Chinese social media. Calls to the court in Wuhan on Thursday rang unanswered.

Liu Yi contributed research.

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Coronavirus Survivors Want Answers, and China Is Silencing Them - The New York Times

The Coronavirus Genome

The coronavirus is an oily membrane packed with genetic instructions to make millions of copies of itself. The instructions are encoded in 30,000 letters of RNA a, c, g and u which the infected cell reads and translates into many kinds of virus proteins.

RNA instructions to make the ORF1a protein

Start of coronavirus genome

Start of coronavirus genome

Start of the

coronavirus

genome

Start of the

coronavirus

genome

In December, a cluster of mysterious pneumonia cases appeared around a seafood market in Wuhan, China. In early January, researchers sequenced the first genome of a new coronavirus, which they isolated from a man who worked at the market. That first genome became the baseline for scientists to track the SARS-CoV-2 virus as it spreads around the world.

Genome Wuhan-Hu-1, collected on Dec. 26 from an early patient in Wuhan

Genome Wuhan-Hu-1, collected on Dec. 26 from an early patient in Wuhan

Genome Wuhan-Hu-1, collected on Dec. 26 from an early patient in Wuhan

Genome Wuhan-Hu-1, collected on Dec. 26 from an early patient in Wuhan

A cell infected by a coronavirus releases millions of new viruses, all carrying copies of the original genome. As the cell copies that genome, it sometimes makes mistakes, usually just a single wrong letter. These typos are called mutations. As coronaviruses spread from person to person, they randomly accumulate more mutations.

The genome below came from another early patient in Wuhan and was identical to the first case, except for one mutation. The 186th letter of RNA was u instead of c.

Genome WH-09, collected on Jan. 8 from another patient in Wuhan

186th RNA letter changed

Genome WH-09, collected on Jan. 8 from another patient in Wuhan

186th RNA letter changed

Genome WH-09, collected on Jan. 8 from another patient in Wuhan

186th

RNA letter

changed:

Genome WH-09, collected on Jan. 8 from another patient in Wuhan

186th RNA letter

changed:

When researchers compared several genomes from the Wuhan cluster of cases they found only a few new mutations, suggesting that the different genomes descended from a recent common ancestor. Viruses accumulate new mutations at a roughly regular rate, so the scientists were able to estimate that the origin of the outbreak was in China sometime around November 2019.

Outside of Wuhan, that same mutation in the 186th letter of RNA has been found in only one other sample, which was collected seven weeks later and 600 miles south in Guangzhou, China. The Guangzhou sample might be a direct descendent of the first Wuhan sample. Or they might be viral cousins, sharing a common ancestor.

During those seven weeks, the Guangzhou lineage jumped from person to person and went through several generations of new viruses. And along the way, it developed two new mutations: Two more letters of RNA changed to u.

Genome GZMU0030, collected on Feb. 27 in Guangzhou

Another RNA letter mutated

This mutation also changed an amino acid

Genome GZMU0030, collected on Feb. 27 in Guangzhou

Another RNA letter mutated

This mutation also changed an amino acid

Genome GZMU0030, collected on Feb. 27 in Guangzhou

Another RNA letter mutated. This mutation also changed an amino acid.

Genome GZMU0030, collected on Feb. 27 in Guangzhou

Another RNA letter mutated. This mutation also changed an amino acid.

Mutations will often change a gene without changing the protein it encodes.

Proteins are long chains of amino acids folded into different shapes. Each amino acid is encoded by three genetic letters, but in many cases a mutation to the third letter of a trio will still encode the same amino acid. These so-called silent mutations dont change the resulting protein.

Non-silent mutations do change a proteins sequence, and the Guangzhou sample of the coronavirus acquired two non-silent mutations.

Amino acid change in the ORF1a protein

Amino acid change in the E protein

Amino acid change in ORF1a

Amino acid change in E

Amino acid change in the E protein

Amino acid change in the ORF1a protein

Amino acid change in the E protein

Amino acid change in the ORF1a protein

But proteins can be made of hundreds or thousands of amino acids. Changing a single amino acid often has no noticeable effect on their shape or how they work.

As the months have passed, parts of the coronavirus genome have gained many mutations. Others have gained few, or none at all. This striking variation may hold important clues to coronavirus biology.

The parts of the genome that have accumulated many mutations are more flexible. They can tolerate changes to their genetic sequence without causing harm to the virus. The parts with few mutations are more brittle. Mutations in those parts may destroy the coronavirus by causing catastrophic changes to its proteins. Those essential regions may be especially good targets for attacking the virus with antiviral drugs.

Total number of amino acid substitutions found in 4,400 coronavirus genomes from Dec. to April

Longer lines may show places where the genome is more tolerant of mutations.

Gaps may show critical spots in the genome that cannot tolerate mutations.

Total number of amino acid changes in 4,400 coronavirus genomes from Dec. to April

Longer lines may show places where the genome is more tolerant of mutations.

Gaps may show critical spots in the genome that cannot tolerate mutations.

Total number of amino acid changes in 4,400 coronavirus genomes from Dec. to April

Longer lines may show places where the genome is more tolerant of mutations.

Gaps may show critical spots in the genome that cannot tolerate mutations.

Total number of amino acid changes in 4,400 coronavirus genomes from Dec. to April

Longer lines may show places where the genome is more tolerant of mutations.

Gaps may show critical spots in the genome that cannot tolerate mutations.

As mutations accumulate in coronavirus genomes, they allow scientists to track the spread of Covid-19 around the world.

On January 15, a man flew home to the Seattle area after visiting family in Wuhan. After a few days of mild symptoms he tested positive for Covid-19. He became the first confirmed case of Covid-19 in the United States.

An X-ray of the patients lungs showed evidence of pneumonia.NEJM

The genome of his virus contained three single-letter mutations also found in viruses in China. They allowed scientists to trace the mans infection to its source.

Genome WA1, collected on Jan. 19 from a man in the Seattle area who visited Wuhan

Genome WA1, collected on Jan. 19 from a man in the Seattle area who visited Wuhan

Genome WA1, collected on Jan. 19 from a man in the Seattle area who visited Wuhan

Genome WA1, collected on Jan. 19 from a man in the Seattle area who visited Wuhan

Identical genomes collected on Jan. 21 in Fujian and Guangdong provinces

Identical genomes collected on Jan. 21 in Fujian and Guangdong provinces

Identical genomes collected on Jan. 21 in Fujian and Guangdong provinces

Identical genomes collected on Jan. 21 in Fujian and Guangdong provinces

Five weeks later, a high school student in Snohomish County, Wash., developed flu-like symptoms. A nose swab revealed he had Covid-19. Scientists sequenced the genome of his coronavirus sample and found it shared the same distinctive mutations found in the first case in Washington, but also bore three additional mutations.

Genome WA2, collected on Feb. 24 from a high-school student in the Seattle area

Genome WA2, collected on Feb. 24 from a high-school student in the Seattle area

Genome WA2, collected on Feb. 24 from a high-school student in the Seattle area

Genome WA2, collected on Feb. 24 from a high-school student in the Seattle area

That combination of old and new mutations suggested that the student did not acquire the coronavirus from someone who had recently arrived from another country. Instead, the coronavirus was probably circulating undetected in the Seattle area for about five weeks, since mid-January.

Since then, viruses with a genetic link to the Washington cluster have now appeared in at least 14 states and several countries around the world, as well as nine cases on the Grand Princess cruise ship.

Genome collected on March 5 from two passengers on the Grand Princess cruise ship

Genome collected on March 5 from two passengers on the Grand Princess cruise ship

Genome collected on March 5 from two passengers on the Grand Princess cruise ship

Genome collected on March 5 from two passengers on the Grand Princess cruise ship

A different version of the coronavirus was also secretly circulating in California. On Feb. 26, the C.D.C. announced that a patient in Solano County with no known ties to any previous case or overseas travel had tested positive.

A sample taken the next day revealed that the virus did not have the distinctive mutations found in Washington State. Instead, it only had a single mutation distinguishing it from the original Wuhan genome. That indicates that it got to California through a separate introduction from China.

Genome UC4, collected on Feb. 27 from a patient in Solano County, Calif.

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How Coronavirus Mutates and Spreads - The New York Times

A broad coalition of US health systems has mobilized to ramp up coronavirus testing in a national effort on a scale not seen since the second world war. But declarations of false victory by the Trump administration and a vacuum of federal leadership have undermined the endeavor, leading experts to warn that reopening the US could result in a disaster.

Interviews with agents on the frontlines of the coronavirus battle lab directors, chemists, manufacturers, epidemiologists, academics and technologists reveal as diverse an application of the legendary American ingenuity as the century has seen.

Test kit manufacturers are running production lines around the clock to triple their output, and triple it again. A private healthcare institute in California has constructed a mega-lab to process thousands of tests daily and deliver the results by text message alert. In smaller labs across the country, microbiologists improvise each day to fill unpredictable supply chain gaps that might leave them without swabs one day, and without crucial chemicals the next.

Its incredible what weve done together over a short period of time, Donald Trump said at a White House briefing this week, praising his administrations response to the pandemic.

But analysts say that without centralized governance and coordination, the national effort remains a competing coalition of state and local outfits hampered by duplicated work, competition for supplies, siloed pursuits of non-transferable solutions and red tape that leaves some labs with testing backlogs and others with excess capacity.

All of which leaves the US without a unified, coherent strategy for testing and contact tracing to contain a virus that does not respect state borders and has already killed more than 60,000 Americans.

Without it, the imminent experiment of reopening the country could be catastrophic, warned Harvard epidemiologist Michael Mina in a conference call with reporters this week.

My concern is that well end up right where we have been, with major cities having healthcare systems that get overrun quickly because of major outbreaks, Mina said.

Im afraid well just end up repeating the past

Meanwhile, as states begin to relax social distancing measures, the Trump administration is spreading dangerous misinformation, denying persistent supply shortages, underestimating the number of Covid-19 cases and exaggerating the margin of safety conferred by the current volume of testing and contact-tracing, experts say.

Weve done more than 200,000 tests in a single day, Mike Pence said at a taskforce briefing this week, in which Trump touted testing as one of the great assets that we have in reopening the US.

But at current testing levels, with only rudimentary plans for contact tracing for new cases, the US will be flying virtually blind as it reopens, said Glen Weyl, a technologist who co-authored a report issued by Harvards Safra Center for Ethics that calls for 5m tests a day by early June.

No, definitely not, you cant open up with that number, Weyl said of Pences announcement. Its not even remotely in the right ballpark. Its off by a factor of 10.

Testing is one of the biggest challenges the coronavirus crisis poses. And as Asian countries that have succeeded in temporarily containing the virus have shown, testing strategy is entwined with the need for contact tracing and isolating confirmed and suspected Covid-19 patients.

There are multiple categories of tests with multiple different modes for sampling, storage and transport. A test might detect the virus itself, detect traces of the virus or detect the bodys reaction to having had the virus. The experience of being tested could be different in each case. One patient might have his or her sinuses probed by a swab at a drive-thru, while another might spit in a tube at home and another give a blood sample at a clinic.

Each test has a different degree of reliability, with different amounts of time and labor required to complete the boomerang curve of sample collection to testing to result report.

We have too many [brands of] tests, and now there are a lot of people who are committed to their tests and they run their tests on their platforms, said Paul Reider, a renowned research chemist in the pharmaceuticals industry who teaches at Princeton University.

We have too many [brands of] tests, and now there are a lot of people who are committed to their tests

If we had an effective administration this is where the federal government comes in they could essentially turn around and say, What we would like to do is, we want one test, maybe two, that are fast, that are accurate, that are scalable and transferable, .

You want a gold-standard test.

In the US, regulatory and administrative hurdles are everywhere, with clinics unable to send samples to private labs that might be out of their usual networks, a lack of protocols for reporting testing data, slow regulatory approval for the use of alternative testing materials, insufficient federal funding to support lab efforts and no central leadership steering the countrys massive laboratory apparatus.

We dont have a system thats ever been built for surveillance, for wide-scale population surveillance or wide-scale testing for people who arent presenting to the hospital or the clinic, said Mina. The demand is just so much larger than our system was built for.

The Trump administrations response to this complicated thicket has been to declare the federal government a supplier of last resort and wish the states luck. Its pretty simple, Trump has said. They have tremendous capacity. We hope to be able to help out.

In an attempt to meet the demand they have encountered, lab scientists have improvised constantly, substituting materials where possible or stacking testing platforms from different manufacturers Roche, Qiagen, Abbott, Hologic, DiaSorin so that if one goes down another can take its place.

The result is that labs have delivered an unprecedented number of tests in record time but with a fraction of the potential efficiency that could be achieved through better coordination, said Reider.

If Jared Kushner wanted to do something decent, and Vice-President Pence, they could try to standardize and distribute nationally a global test, said Reider. At least make it available and let people choose if they want to use it.

The Harvard report called for the establishment of a Pandemic Testing Board akin to the War Production Board that the United States created in World War II. The director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota calls for a new Marshall plan to stand up testing in the US.

But no efforts to create such a central authority are apparent, said Michael Osterholm, CIDRAP director, who described a shortage of reagents, or chemicals used in testing, on his Osterholm Update podcast this week.

We have had a number of our testing laboratories unable to get the needed reagents they couldve and shouldve had to increase testing, Osterholm said. We really need a Marshall plan where the federal government and the private sector get together and decide what are the challenges, what can we do to quickly boost these reagents, what can we do to actually increase the reagent pool?

Demand signal or no, some big private sector players have already moved aggressively. Early on in the crisis, Color, a private healthcare institute that does genomic testing in California, resolved to stand up a mega-lab that is now on the verge of processing 10,000 tests a day, with a goal of expanding that capacity by an order of magnitude, said Othman Laraki, CEO.

The company has since partnered with the city of San Francisco to provide Covid-19 testing for all private-sector and nonprofit essential employees, as well as any resident with symptoms who cannot find testing elsewhere. Next-day results are delivered via email and text-message alerts.

Our thinking was that you needed to have a few massively scaled labs as opposed to having a big sprinkling of small-scale labs, Laraki said. We believe thats the way to build the type of capacity thats needed really to bring the country back to work.

In Minnesota, academics at the state university partnered with scientists at the Mayo clinic, one of the countrys premier labs, to deliver on a challenge by governor Tim Walz to stop coronavirus in the state with comprehensive testing and contact tracing.

We really need a Marshall plan where the federal government and the private sector get together

We just made the decision that were probably going to be on our own and that we need to be ready to care for our patients, said Tim Schacker, vice-dean for research at the University of Minnesota and an architect of the project.

As a first step, the scientists invented a molecular test that was mostly independent of the supply chain problems, Schacker said.

Robin Patel, the president of the American Society for Microbiology, said supply chain issues continue to represent a daily challenge for laboratories, from swabs to chemicals to materials used to extract viral RNA and amplify DNA.

The situation has changed, yes, but its a different situation every day, so using the word improved is I dont think appropriate, she said.

This isnt just an American situation. People throughout the world are dealing with the same issues. The supply chain were talking about is not just an American supply chain, its a worldwide supply chain.

To celebrate Americas reopening, Trump appears to be preparing to hit the road, with plans to visit warehouses and factory sites to advertise the economic comeback he has promised. We built the greatest economy the world has ever seen, Trump said this week. And were going to do it again. And its not going to be that long. OK?

Polling indicates that a majority of Americans does not share Trumps optimism. About two in three Americans think restrictions on restaurants, stores and other businesses are appropriate, and 16% on top of that wanted tighter restrictions, a poll this week from the Washington Post and the University of Maryland found.

Top epidemiologists believe its possible that the US could get some kind of reprieve from the virus in the warmer months ahead. If that happens, the summer could feature the scenes Trump has dreamed about, of packed churches, humming factories, crowded beaches and sold-out flights.

But Trumps dream that the virus will simply disappear is just that a dream, epidemiologists say.

I hope that over the course of the next few weeks to two months, were going to actually see a substantial reduction in transmission, Osterholm said. And if it does, it shouldnt be interpreted that we won, or that somehow were in control.

I hope that the case numbers continue to decrease over time, but Im also very, very aware that theyre coming back, and we just have to remember that.

Read more:

No leadership and no plan: is Trump about to fail the US on coronavirus testing? - The Guardian

When a relative of mine recently became seriously ill with what seemed to be a coronavirus infection, my first question was about timing. How many days ago did your symptoms start?

Marking your calendar at the first sign of illness, and tracking your fever and oxygen levels, are important steps in monitoring a coronavirus infection. Covid-19, the disease caused by the coronavirus, has been unpredictable in the range of symptoms it can cause. But when it turns serious, it often follows a consistent pattern.

While most patients recover in about a week, a significant minority of patients enter a very nasty second wave of illness, said Dr. Ilan Schwartz, assistant professor of infectious disease at the University of Alberta. After the initial symptoms, things plateau and maybe even improve a little bit, and then there is a secondary worsening.

While every patient is different, doctors say that days five through 10 of the illness are often the most worrisome time for respiratory complications of Covid-19, particularly for older patients and those with underlying conditions like high blood pressure, obesity or diabetes. Younger patients who develop complications may begin struggling a little later, as late as days 10 to 12. Most people who reach day 14 without any worrying symptoms (other than feeling miserable and fatigued) are likely to be on the road to recovery.

With any other disease, most people, after a week of symptoms, theyre like OK, things will get better, said Dr. Leora Horwitz, associate professor of population health and medicine at N.Y.U. Langone Health. With Covid, I tell people that around a week is when I want you to really pay attention to how youre feeling. Dont get complacent and feel like its all over.

Its important to call a doctor if you have shortness of breath or any concerning symptom no matter what day of illness you are on. And dont panic if you still feel lousy after a week of illness. Its common for Covid symptoms to linger, and feeling unwell for more than a week doesnt always mean you need medical treatment.

But tracking symptoms and paying special attention as the illness nears its second week has taken on new urgency as more doctors are seeing patients arriving at the hospital with an insidious form of pneumonia. On scans, patients with Covid pneumonia have a finding called ground-glass opacities, a hazy appearance in the lower part of both lungs. Oxygen levels may drop so slowly that the patient doesnt even notice, a condition called silent hypoxia. Often it is not until oxygen saturation reaches dangerously low levels, causing severe shortness of breath, that they finally seek care.

The best way to monitor your health during this time is to use a pulse oximeter, a small device that clips on your finger and measures your blood oxygen levels. (There are phone-based apps meant to do this, but they have tested poorly) The normal oxygen saturation range is about 96 to 99 percent. If your blood oxygen reading drops to 92 percent, its time to call a doctor.

While at home, you can also increase the flow of oxygen to your lungs by not resting on your back. Resting on your stomach, in the prone position, can open parts of the lungs that are compressed when lying on your back. You can also change to resting on your left side or right side, or sit upright in a chair.

Dr. Anna Marie Chang, an associate professor of emergency medicine and director of clinical research at Thomas Jefferson University, was sick for about a week before her oxygen levels dropped to 88 on the ninth day of her illness. She went to the hospital and was treated with oxygen and rested mostly in the prone position for four days to recover.

Its not clear why relatively young, healthy patients like Dr. Chang, who is 38, sometimes take a turn for the worse.

The first part is viral illness and everything else, said Dr. Chang. Your body is developing your immune inflammatory response and trying to fight off infection. That system can get over stimulated, and that seems to be what causes the acute worsening. Were seeing that around days seven to 10.

Dr. Chang cautioned that patients should listen to their bodies and not be too strict about following a timeline of symptoms. The human body does not follow the perfect manual, she said.

The problem, say doctors, is that the public health guidance so far has been to tell patients to ride out the illness at home and seek medical care or return only if they experience severe shortness of breath. As a result, too many patients are waiting too long to contact a doctor.

From a public health perspective, weve been wrong to tell people to come back only if they have severe shortness of breath, said Dr. Richard Levitan, a well-known emergency room doctor from New Hampshire who has called for widespread use of home pulse oximeters during the first two weeks of Covid-19 illness. Toughing it out is not a great strategy.

Dr. Levitan notes that while many patients may take a turn for the worse five to 10 days into the illness, he hesitates to be too specific about the timeline because not every patient is clear about exactly what day their illness began.

Patients will sometimes define a time course of illness differently than what you would expect, Dr. Levitan said. When you ask someone how long have you been sick, I find a patient says a few days and his wife will say, no, hes been sick for a week.

But what if you dont have a home pulse oximeter to monitor your health? The devices are now in short supply or can take weeks to be delivered.

Some medical practices are sending their patients home kits that include pulse oximeters, so check with your doctor about how you might be monitored. Ask friends now if they have a pulse oximeter so you have a plan in place to borrow one for two weeks should you get sick (the device is easily sanitized).

If you are still feeling lousy a week into your illness and dont have a pulse oximeter, you can also check in with an urgent care clinic and ask them to check your oxygen level. If you are concerned, talk to your doctor about whether a visit to an urgent care center or the emergency room is warranted.

In the absence of a pulse oximeter, one rough measure of respiratory function is a self-test called the Roth score. It requires the patient to take a breath and try counting to 30. If a patient cant make it to the number 10 (or seven seconds) without another breath, its likely their oxygen level has dropped below 95. If they cant count to the number 7 (or five seconds), their oxygen score may be below 90 percent. The test is not perfect, nor has it been studied in Covid-19. A University of Oxford team said the Roth score should not be used because it hasnt been validated and could give false reassurance.

Another physical but subtle sign of falling oxygen: Patients may start taking short, fast breaths to compensate, although they may not notice they are doing it. Patients with low oxygen levels might also have a blue tinge to their lips or skin. Thats why a video conference with your doctor can be helpful if youre not sure about whether you need to go to the hospital.

Heres a look at the timeline of Covid symptoms. While this can serve as a general guide, symptoms can appear at any time. Always listen to your body and consult with a doctor for guidance about your specific case.

Early symptoms of Covid-19 vary widely. It can start with a tickle in your throat, a cough, fever, headache and feeling winded or just a little pressure in your chest. Sometimes it begins with a bout of diarrhea. Some people just feel tired and lose their sense of taste and smell. Many people have several symptoms but no fever. Some patients with gastrointestinal symptoms go on to develop respiratory symptoms, while others dont.

Some patients never develop more than mild symptoms, or none at all. Others begin to feel terrible, with an ever-present fever, aches, chills, cough and an inability to get comfortable.

Some children and younger adults with mild disease may develop rashes, including itchy red patches, swelling or blistering on the toes or fingers, similar to frostbite. The exact timing isnt clear, and the symptom may appear early in the infection or after it has passed. Thats what happened to Dr. Schwartz, who developed respiratory symptoms and then blisters on his feet. It seems that a lot of these individuals, including myself, test negative on coronavirus swab tests, he said. I presume its a false negative. It could be that what were seeing is an immunological phenomenon that occurs after the initial infection is on the mend.

For some lucky patients with mild illness, the worst is over after a week. Guidelines from the Centers for Disease Control and Prevention say patients whose symptoms have improved and who havent had a fever for three days can leave isolation.

But some patients who have felt terrible continue to feel terrible or get worse. And some patients might start to feel better briefly then take a turn for the worse.

Patients should monitor their oxygen levels and check in with a doctor if they start to feel unwell. We should instruct patients to have a lower threshold for contacting their doctor, Dr. Levitan said. I believe they should contact their physicians to have monitoring if theyre feeling worse.

Monitoring should continue for the second week of illness. Patients may feel better sleeping on their stomachs or sides.

Days eight to 12 are when we have a really good idea if someone is going to get better or get worse, said Dr. Charles A. Powell, director of the Mount Sinai-National Jewish Health Respiratory Institute. The major thing we worry about is a worsening at eight to 12 days an increasing shortness of breath, worsening cough.

Dr. Powell said a home oxygen monitor can signal if someone needs to come in. Otherwise, patients should talk to their doctors.

If its difficult for the person at home to feel comfortable, and its difficult for the family to feel things are manageable, that would lead a physician to suggest the patient come in for evaluation, said Dr. Powell. We dont want to wait too long for blood oxygen levels to get worse.

Patients who had mild illness should be well recovered. Patients who had worse symptoms but maintained normal oxygen levels should feel mostly recovered after two weeks. However, patients with severe symptoms and those who needed additional treatment because of low oxygen may still feel unwell and fatigued and take longer to recover.

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Why Days 5 to 10 Are So Important When You Have Coronavirus - The New York Times

The ship, which is currently in port in San Diego, was the second US warship to be struck by an outbreak of the pandemic after the USS Theodore Roosevelt aircraft carrier.

The officials said that there are more than 95 cases currently aboard the ship, meaning that almost 30% of the crew has been infected, surpassing the infection rate for the USS Theodore Roosevelt which has seen approximately 24% of its crew infected.

The handing of the outbreak aboard the aircraft carrier led to the firing of the ship's commanding officer, and the resignation of the acting Navy Secretary. It has been the subject of a Navy investigation which is due to be completed on May 27 following an initial preliminary inquiry that officials tell CNN recommended that the aircraft carrier's former captain, Capt. Brett Crozier, be reinstated.

The Navy on Friday stopped providing official daily figures about the number of cases on the Kidd and Theodore Roosevelt, saying that it "will only report significant changes on these vessels and new cases on any other deployed vessels."

On Thursday night, a Navy statement said that official number of active coronavirus cases on the Kidd was 78.

The 20% increase in positive coronavirus cases does not appear to have met the Navy's definition of "significant" information.

The statement Thursday said that the USS Theodore Roosevelt had 1,102 active cases in addition to 53 sailors who have recovered from coronavirus after completing at least 14 days in isolation and two successful negative tests. Three sailors from the ship are being treated in US Naval Hospital Guam for coronavirus symptoms. None of those sailors are in the ICU.

Asked about the new policy, chief Pentagon spokesperson Jonathan Hoffman told reporters at the Pentagon "we wanted to get out of the pattern of providing a daily tracker of minor changes."

"We've now reached a point with both of those ships, particularly with the (Theodore Roosevelt), where we've gone through, the entire crew's been off, the entire crew's been tested, we have the results, the ship has been cleaned, the crew is now returning to the ship. So we believe that we have moved past a point where the daily updates are providing useful information for a public conversation about it," Hoffman said.

"If there was unfortunately an additional outbreak, we would provide information. But we wanted to get out of the pattern of providing a daily tracker of minor changes in this. And I think that's a reasonable place to be," Hoffman added.

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Number of coronavirus cases from second warship outbreak nears 100 as Navy restricts information on pandemic - CNN

Up to 2% of Moscows population may be infected with coronavirus, the citys mayor warned on Saturday, as hospitals in the Russian capital were overwhelmed and another top government tested positive.

Covid-19 took hold relatively late in Russia, but is now growing fast, with the country showing the second-highest spread of the disease in the world. A record 9,623 new cases on Saturday indicated infections have not yet reached a plateau.

If Moscow mayor Sergei Sobyanins estimate is correct, that would mean more than 240,000 people may have the virus, four times official figures for the city. Hospitals in the capital are already at capacity, with television footage showing ambulances forced to wait for hours to deliver the infected.

On Friday authorities announced the housing minister was the latest top official to test positive. Vladimir Putin has not been pictured in public for nearly a month and is working from his residence outside Moscow.

There are fears outbreaks may have festered undetected in other areas that initially appeared to have escaped the worst ravages of the disease.

In Somalia, medics, funeral workers and gravediggers have reported an unprecedented surge of deaths in recent days in the capital Mogadishu, suggesting official counts of Covid-19 deaths -- currently just 601 confirmed cases and 28 deaths -- reflect only a fraction of the viruss toll.

Mohamed Osman Warsame, an ambulance driver, said he had transported between 15 and 18 corpses to cemeteries in the capital every day for the last two weeks, many times above the usual daily figure of between two and four. There are a lot of deaths. It is like we are in a deadly war. People are dying so fast, Warsame said.

On the island of Bali, an entire hamlet has been locked down after rapid testing showed hundreds of residents were probably infected, the Jakarta Post reported. Out of 1,200 initial tests, 400 returned a reactive result; authorities will follow up with swab tests to confirm infection rates.

Increasingly intense efforts to stop the spread of the disease have raised concerns about human rights and civil liberties. Malaysia has been criticised by the UN after detaining hundreds of undocumented migrants, including young children and Rohingya refugees, as part of its efforts to contain coronavirus.

The UN said the arrests could push vulnerable groups into hiding and prevent them from seeking treatment, and warned that overcrowded detention centres carried a high risk of increasing the viruss spread.

Privacy advocates in India have also attacked a government order that all public and private sector employees should use a government-backed Bluetooth tracing app, as New Delhi begins easing some of its lockdown measures in lower-risk areas.

Critics warn that it is unclear how the data will be used. They stress India lacks privacy laws to govern the app. New Delhi has said the app will not infringe on privacy as all data is collected anonymously.

Worldwide there are now 3.4 million cases of coronavirus and more than 238,000 deaths, although many countries that have passed the peak of their infections are now working on relaxing their lockdown restrictions.

Singapores health minister said on Saturday that it will start easing some curbs after a second wave of the coronavirus concentrated in the states crowded migrant worker dormitories appeared to subside, with some students allowed back to school later this month.

In Spain on Saturday adults were allowed out to exercise for the first time since March; as the country goes back to work, the government has made facemasks compulsory on buses, tubes and trains. Nearly 15 million will be handed out by authorities and charities.

All governments, however, are moving cautiously, for fear of a second wave. In China the northeastern city of Harbin shut-dine in services at restaurants and cafes as the rest of the country was easing restrictions for the May Day holiday.

Mainland China reported only one new case on Saturday, but Heilongjiang province is currently dealing with the countrys biggest remaining coronavirus cluster, with half of 140 recent local transmissions, according to a Reuters tally.

In the US, Australia and the UK, there has been a focus on how and why residential facilities have become deadly incubators for the disease.

A nursing home in New York has reported a horrifying death toll of 98 people from the coronavirus, one of the worst outbreaks in the country and a shock even in hard-hit New York. An official state tally of nursing home deaths had previously listed only 13 as of Friday.

In the UK, the coronavirus death toll increased sharply this week after officials began counting fatalities from the countrys nursing homes alongside deaths in hospitals. Britain now has the third highest number of deaths in the world, 27,510, according to the Johns Hopkins University tracker, behind only the US and Italy.

In Australia, although the virus has been brought under control far more quickly, deaths also continued to mount at a care home in western Sydney. Thirteen residents account for over 10% of the total national death toll of only 93, and it is threatening to overtake the Ruby Princess cruise ship as the single biggest source of deaths in the country.

Elsewhere around the world, key developments include:

The US Federal Drug Administration has given approval for the experimental drug remdesivir to be used in an emergency on patients suffering from Covid-19.

Also in the US, the White House has barred the administrations top pandemic expert, Dr Anthony Fauci, from giving evidence at a Congressional hearing. It said it was not appropriate for a member of the pandemic response team to testify.

Europes tourism industry, and its host economies such as Spain, Italy and Greece, face being ruined by the shutdown driven by the virus. The European Commission estimates that the EUs hotels and restaurants will lose half their income this year.

The UK government has been urged to prioritise spending on the poorest areas of the country after official statistics revealed that those regions have borne the brunt of the deaths from Covid-19. Read our report on life in one of the nations poorest boroughs, Newham in east London.

The economic toll of the crisis has continued as stock markets fell sharply on Friday, largely thanks to the ongoing war of words between the US and China. In the UK, the Financial Times has reported that Rolls-Royce plans to shed 8,000 of its 52,000-strong workforce.

Californias governor, Gavin Newsom, promised to make meaningful changes to stay-at-home orders in the coming days as thousands of protesters gathered across the state to condemn the lockdown, and in defiance of its ordnances.

Donald Trump has told Michigans governor, Gretchen Whitmer, that she should make a deal with anti-lockdown protesters after groups of heavily armed men swarmed the state capitol. Whitmer rejected making a deal during a public health emergency, but said some outdoor work will be allowed to resume next week.

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Russia now has second-highest rate of Covid-19 spread as other countries ease restrictions - The Guardian

Not even Warren E. Buffett was spared financially from the coronavirus, as his conglomerate, Berkshire Hathaway, reported a $49.7 billion loss in the first quarter on Saturday, reflecting the outbreaks toll on an investment portfolio that includes big stakes in major airlines and financial firms.

The loss was Berkshires biggest ever and a sharp swing from a $21.7 billion profit in the same quarter a year earlier. The conglomerates vast array of investments exposed it and Mr. Buffett, long considered one of the worlds top investors to huge swaths of the battered American economy.

Its total investment loss for the quarter, without accounting for operating earnings, was $54.5 billion. By comparison, its investment gain in all of 2019 was $56.3 billion.

Berkshires investment loss tracked the overall slide in stock markets: The S&P 500 dropped 20 percent in the first quarter. (The companys biggest holdings are also mainstays of the S&P 500: American Express, Apple, Bank of America, Coca-Cola and Wells Fargo, with those stakes amounting to nearly $125 billion.)

The loss overshadowed a 6 percent rise in Berkshires operating earnings, which track the performance of the companys owned-and-operated businesses like the insurer Geico. Mr. Buffett regards that as a better measure of the companys overall performance and has long argued that quarterly paper gains or losses on its investments are often meaningless in understanding its overall health.

But it is hard to ignore the damage to a portfolio that includes stakes in financial firms like Bank of America and American Express, both of which reported steep drops in earnings for the first quarter, and four of the biggest U.S. airlines. (Berkshire also disclosed that the value of its stake in Kraft Heinz on its books exceeds the market value of that holding by about 40 percent, and warned that it might have to take a write-down on the investment in the future.)

Even some of the conglomerates wholly owned businesses, like the Burlington Northern Santa Fe railroad and retailers like Sees Candy, were hurt by the lockdowns that have shaken the U.S. economy. Still, Geico reported a 28 percent gain for the quarter, to $984 million, while Berkshires overall insurance investment profits rose modestly because of increased dividend income for the company.

The first-quarter results were released ahead of Berkshires first-ever online-only annual shareholder meeting. It is a change, made necessary by the pandemic, to an event that usually draws tens of thousands of investors to an arena in Omaha to listen to Mr. Buffett expound on the state of capitalism, business, politics and much more.

Absent from the meeting will be Berkshires 96-year-old vice chairman, Charles T. Munger, who lives in Los Angeles. But Gregory Abel, who is one of Berkshires top executives and considered a potential successor to Mr. Buffett, will attend in person.

Shareholders, who can submit questions for Mr. Buffett to answer live, are likely to be interested in what investment opportunities lie ahead for Berkshire, which reported having $137.3 billion in cash at the end of the quarter. In contrast to his actions during the financial crisis of 2008, when Mr. Buffett extended lifelines to American corporate giants on hugely profitable terms for himself he has not talked about what bargains exist in the pandemic era.

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Berkshire Hathaway Lost $49.7 Billion in First Quarter Stung by Coronavirus - The New York Times

A group of nurses from Northwestern Memorial Hospital in Chicago share the moments that have made the long, hard days worth it. USA TODAY

CHICAGO Dressed in jeans, a striped collared shirt and white sneakers emblazoned with the words MADAM and MAYOR on the heels, the 5-foot former prosecutor grooved to the syncopated beat as the first lyrics rang out: Cash on me, like I hit the lottery.

It's not the typical image for a big-city mayor. Especially during the COVID-19 era.

Mayor Lori Lightfoot on Thursday announced Chicago's first-ever citywide celebration of graduating seniors via a video of herself dancingposted to TikTok the most recent in a series of viral social media posts that Lightfoot's office has used to encourage residents to stay home amid the coronavirus outbreak. More than than 22,000 Chicagoans have been infected; 962 have died.

In an exclusive one-on-one interview with USA TODAY, the Chicago mayor talked about the challenges of battling COVID-19 on the political front lines and her personal experience of the outbreak.

Lightfoot, 57, the Windy City's first black woman and first openly gay mayor, has gained national attention for effectively shepherding the nation's third-largest city through the crisis of a generation.Her humor and iron-fisted resolve have provided both welcome levity and comfort for many Chicagoanswatching the citys case count creep upward.

But in a city long dominated by a history of machine politics and mayoral boses, critics warn that Lightfoot is capitalizing on the crisis to consolidate authority at City Hall.

For the new mayor navigating an impossible situation, the outbreak has meantthree months of seeing the inequities within her city laid bare. It'sbeen acrisis colored by loss, resilience and a letter written in orange marker.

"I have a range of emotions,"Lightfoot says. "People are stepping up in really amazing ways . . .But I also recognize that, just as our strength shines through, the vulnerabilities that we all knew about, that we've been working on for years in fact decades those are also flashing like a neon sign."

In Chicago and Detroit: Coronavirus spares one neighborhood but ravages the next. Race and class spell the difference.

Chicago has been held up as an example of how the outbreak is disproportionately affecting communities of color. The city gained national attention in early April when it reported that more than half of its coronavirus patients and about 70% of COVID-19 deaths were among African Americans, even though black Chicagoans make up just 30% of the citys population.

At the time, the city didn't have information about the race or ethnicity of a quarter of all cases. Looking back on the few past months, Lightfoot said that's among her biggest regrets.

"Understanding the disparate impact is really important," Lightfoot said. "I wish we had demanded the demographic information compliance sooner."

Mayor Lori Lightfoot answers a reporters question during a news conference to provide an update to the latest efforts by the Racial Equity Rapid Response Team in Chicago on Monday.(Photo: Tyler LaRiviere/Chicago Sun-Times via AP)

For thousands of Chicagoans, those case counts aren't just statistics they're family, friends, nurses, doctors. For Lightfoot, it was a man she had met last year whoworked with at-risk youth.

"He had underlying conditions, but nothing particularly serious, and was starting to recover, then literally overnight took a turn for the worst. It was shocking to me," Lightfoot said. "That he lost his life in that way, its very painful."

Lightfoot said a note that she received from a boy in her neighborhood has been giving her the strength to work through the pain.

"It was a very short, sweet letter, and he basically said he was writing to thank me for what we were doing in the city," she said. "Ive been carrying that around because that meant so much to me."

The humor's helped, too, Lightfoot said. When the mayor closed down the city's Lakefront Trail at the end of March, a local graphic artist photoshopped an image of Lightfoot, hands clasped and stony-faced,into a picture ofthe fenced off trail.

"It really just kind of took off from there," Lightfoot said. "We just decided to take the moment of humor to really burn in the necessity to stay home and save lives. The level of ingenuity of people in this city really knows no limits. Its been very fun."

Memes of Lightfoot standing watch outside houses, perched atop traffic lights, glaring through rear-view mirrors, ordering Jesus back into the cave on Easterand more have circulated online.

An Instagram account called "whereslightfoot" has nearly 60,000 followers. The trend is so popular, it's become self-referential.

If she had to pick, two memes stand out as favorites, Lightfoot said.

"It was pretty early on, somebody did a Wheel of Fortune that said 'Stay the F*** Home' that I still think about and laugh every time.It just caught me and made me laugh," she said. "I think the one thats probably truly my favorite, there's one where you know the bat signal that beams up with my face? I kind of feel like that. I need to be and hope I am the guardian of this city."

Criticssay they're getting that message loud and clear. Last week, during a raucous City Council meetingover Zoom complete with shouting and expletives aldermen criticized a proposal to grant Lightfoot'sadministration emergency powers to make decisions about COVID-related spending. Critics called the move a "power grab" by the mayor, who campaigned on rooting out corruption in City Hall.

The ordinance passed, with 21of 50 aldermen votingagainst the measure, including several aldermen representing communities disproportionately affected by the virus.

Democratic Socialist Ald. Carlos Ramirez-Rosa voted against the ordinance, saying that it did not include oversight measures or guarantees that the emergency dollars would be prioritized for hardest hit communities.

"We have been told to trust this mayor,"Ramirez-Rosa said in the meeting. "Here in Chicago, weve seen the disastrous effect of when we trust the mayor to be Chicagos sole decision-maker and authority."

Echoing a critique of Lightfoot commonly heard amid last fall's 11-day teacher's strike, Ramirez-Rosa said that "when it comes to this mayor, you have got to put it in writing."

"We cannot go back to the times of one mayor overseeing everything and a rubber-stamp council," said Ald.Byron Sigcho Lopez.

As Lightfoot turns her focus toward a gradual reopening of the city, June 1 looms large in her mind. Last week, the mayor put together a team of local officials, business leaders and activists to advise her on plans for recovery.

"First of all, were going to be doing a change study. Were looking at uncovering the effect of COVID across a lot of sectors economic, but what I call the social fabric, how this has impacted individuals, neighborhoods, communities," Lightfoot said. "The goal is to have a final report by June 1. So its a sprint."

Lightfoot said that in addition to a focus on policy and economic recovery, the task force plans to have working groups focused on regional cooperation and mental and emotional health. The groups were developing a process to get public feedback, she said.

"We want to think very thoughtfully about what a staged reopening looks like," she said. "Because its not going to look the same as it did in February, pre-COVID. Its just not. Not until we get a vaccine thats viable. So its turning on the dimmer light and not flipping the switch."

When will US reach 100,000 deaths?After a horrific April, grim milestone could hit in May

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Coronavirus in Chicago: How the mayor of the nation's 3rd-largest city is waging her biggest fight - USA TODAY

A new test for the coronavirus is so simple and straightforward, almost anyone could do it: Spit a glob of saliva into a cup, close the lid and hand it over.

While not as fast to process as the speediest swab tests, saliva tests could transform the diagnosis of Covid-19. If manufactured in enough numbers and processed by enough labs across the country, they could alleviate the diagnostic shortages that have hampered containment of the pandemic and offer a less onerous way for companies to see if workers are infected.

The first saliva-based test, already being offered in parts of New Jersey, detects genetic material from the virus, just as the existing tests do, but it avoids a long swab that reaches disturbingly far up a persons nose. For the saliva-based, health care workers do not need to wear and discard precious gowns and masks. And early evidence suggests it is just as sensitive, if not more so, than the swabs.

Because the saliva test relies on equipment that is widely available, it also offers the hope of a nationwide rollout without encountering the supply problems that have plagued the swabs.

Starting about two weeks ago, New Jersey has offered the saliva test at a walk-up site in New Brunswick; drive-through sites in Somerset and Edison; the states Department of Corrections; 30 long-term care facilities; and even the American Dream mall.

Experts not involved with the test praised it as a welcome solution to diagnostic shortages across the country.

If people are going back to work, and theyre going to be tested presumably on a regular basis, we really do need to have less invasive sampling methods than the swabs, said Angela Rasmussen, a virologist at Columbia University. To have to do nasopharyngeal swabs twice a week? No, thanks.

The next step would be an at-home saliva test kit that skirts even the need to go to a walk-in center, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security.

Dr. Adalja noted that LabCorp, one of the nations largest commercial laboratories, now offers an at-home test that people can use to swab their own nose. If we can do nasal swabs unsupervised, theres no reason why we cant do these tests unsupervised as well, he said.

On April 13, the Food and Drug Administration granted an emergency-use authorization, waiving some usual requirements, to a saliva test made by a Rutgers University lab, RUCDR Infinite Biologics.

The Rutgers lab has already processed close to 90,000 tests, according to its chief executive, Andrew Brooks, and expects to ramp up eventually to 30,000 tests per day. Results are available within 72 hours, although they could be sped up to just a few hours with enough infrastructure in place. By contrast, some rapid tests that rely on swabs deliver results in minutes.

Other states are expressing interest. Working with Rutgers, Oklahoma has begun validating a version of the test, and the Rutgers researchers have fielded questions from the White Houses coronavirus task force, from Indiana, Illinois, California and from several large companies. In New Jersey, the test is available for between $65 and $100.

After a disastrously slow start, the United States is starting to see an increase in testing types and capacity. The National Institutes of Health on Wednesday announced a new $1.5 billion shark tank style program aimed at encouraging swift innovation in coronavirus testing, with a goal of new tests by the end of summer. Also Wednesday, the testing manufacturer Hologic said that it had a new test that could allow labs to begin running up to 1 million additional tests per week.

The nasopharyngeal swabs that have mostly been used to test for the coronavirus are invasive and uncomfortable, and may be difficult for severely ill people to tolerate. They also put health care workers at high risk of infection and require them to wear gloves, gowns and masks.

The saliva test, by contrast, doesnt require any interaction with a health care worker. And its easy enough that New Jersey has also started using it at developmental centers with residents who have intellectual and developmental disabilities.

The saliva is immersed in a liquid that preserves it until it can be analyzed. This will be particularly important for developing tests that people can use at home and mail or drop off at a lab, or when dealing with large numbers of samples.

When youre testing 10,000 at a drive-through a day, when youre at a correctional facility collecting it from 1,500 people per day, the use of a preservation agent is really critical, Dr. Brooks said.

He said that the preservative in the Rutgers test is a secret sauce made by a Utah-based partner, Spectrum Solutions, but that the ingredients are easily available and unlikely to pose supply problems.

However, some of the PCR machines, which amplify viral genetic material, require labs to use the manufacturers own reagents. That could potentially be a supply issue, Dr. Rasmussen said.

The Rutgers test was validated in people who were severely ill, but the saliva test often yielded a stronger signal than the swab, suggesting that it is more sensitive yielding fewer false negatives than the swab. It also generated no false positives in all of the samples tested.

False negatives in particular have been a problem with the nasopharyngeal swabs. (A different type of test for antibodies, which can say whether a person was exposed to the virus and has recovered, is riddled with false positives.)

In separate research, a Yale University team reported that saliva may be able to detect the virus in people who are only mildly ill, while a nasopharyngeal swab cannot.

In their study, the team compared swabs and saliva samples from patients. They needed only a few drops of saliva for their test, an advantage for people who may have trouble producing more. Thinking about a favorite meal can often do the trick, said Anne Wyllie, the Yale teams leader.

The swabs are known to produce false negatives perhaps in part because of errors by health care workers under stress. The saliva test appeared to be more consistent and accurate over a longer period of time, detecting infections even after the amounts of the virus have waned, than the swab.

The nasopharyngeal swab is subject to so much more variability in how well its obtained, Dr. Wyllie said. A saliva test is definitely more reliable.

In one case, the team found a health care worker who twice tested negative using a nasopharyngeal swab before finally testing positive on a third day. But the workers saliva tested positive all three days, Dr. Wyllie said. She underlined the risks of asymptomatic health care workers getting a false negative and continuing to care for patients. You can imagine the implications, she said.

While the Yale team did not compare saliva tests with the shorter swabs used in some tests, Dr. Wyllie said she expected that saliva tests would prove superior there as well. Most people with Covid-19 do not have runny noses, which might influence how much virus a short swab can collect, she said.

Saliva tests would also be a preferred choice for at-home tests, Dr. Adalja added. A saliva test for H.I.V. is the only at-home test approved for an infectious disease, he said, but before the pandemic, the federal Biomedical Advanced Research and Development Authority had funded two companies to develop at-home nasal swab tests for influenza.

Its not a high bar to repurpose home testing for the coronavirus, he said. Its not something thats out of reach.

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New Coronavirus Test Offers Advantages: Just Spit and Wait - The New York Times

Will there be another wave of Covid-19? And if so, how big will it be, and will there be more waves after it?

The answer to those questions depend on seasonality, the susceptibility of the population to the disease, the rate at which the coronavirus mutates and how we come out of lockdown.

Colds and influenza are seasonal because those viruses generally survive outside the body for a shorter time in high heat and high humidity than in cold weather and low humidity. People also spend more time indoors in winter, coming into close contact with others with less ventilation, so respiratory infections are far more common in winter, although of course they can sicken people in summer, too.

But in 1918 and 1919, the years of the worlds deadliest pandemic, the seasons seemed to have little impact on the influenza.

That pandemic had a mild first wave which began in February 1918. It struck relatively few places in the United States or around the world, followed by a lethal second wave which began in Switzerland in late July and spread rapidly around the world from September to December 1918, hitting the Northern and Southern Hemispheres simultaneously. (Australia was hit late; its rigid quarantine of arriving ships delayed the pandemics arrival until January 1919, the middle of its summer.) Then a third wave began in February 1919, marking two distinct pandemic waves in the same influenza season, a highly unusual occurrence.

Susceptibility clearly was a more important factor than the seasons, because it turned out that the entire world young and old people on every continent was susceptible to the disease.

Mutation was also an important factor. It probably accounts for the timing of the third wave in 1919: It seems likely that by then, the virus had changed enough that any immunity to the initial virus didnt protect well against its mutated form. This hypothesis is supported by the fact that exposure to the first wave provided up to 89 percent protection against second wave illness (the best vaccine in the last 15 years provided 62 percent protection), but neither first nor second wave exposure protected against that third wave.

What does all this mean now?

Nothing is certain and little is known about Covid-19, but a few things are likely.

First, modelers estimate that the true number of infected persons is up to 20 times the reported number, which still leaves about 95 percent of the population susceptible. If, as in 1918, susceptibility proves more important than seasonal influences, hot weather will not give as much relief as hoped for. By the same token, that would mean the expected seasonal surge when colder weather arrives might not be as large as feared.

Second, Covid-19 mutates much more slowly than influenza, and its key spike protein the part of the virus that attaches to cells seems particularly stable. Amid all of the bad news that this virus has brought, this characteristic of the virus is a silver lining in several ways.

Since the virus does not mutate nearly as fast as influenza, this reduces almost to zero the chance that it will become more virulent, as happened in 1918. Moreover, because the spike protein is a key part of the virus likely to be recognized by the immune system, then mutation will probably not account for a new wave soon. For the same reason, the consensus view of virologists seems to be that those who recover from the illness probably develop immunity lasting a year and possibly longer, and that a vaccine will most likely protect reasonably well against Covid-19.

Third, the incubation period, on average nearly six days, is roughly triple the average incubation period of influenza, and the disease itself takes much longer for people to recover from and stop shedding virus. Therefore even without social distancing it would take months for the outbreak to pass through a community, as opposed to six to 10 weeks for influenza. With social distancing necessary to reduce deaths by keeping hospitals from being overwhelmed it will take even longer. Additionally, the incubation period allows an asymptomatic person more opportunity to spread disease.

But these factors will give the country more time to expand testing and contact tracing, and to isolate and quarantine contacts. All of those are impossible with fast-spreading influenza.

How then do we restart the economy? We cannot simply wait for herd immunity to develop from natural infection. That would take many months and be accompanied by an unacceptable death toll. Nor can we wait a year or more for a vaccine.

Instead, a consensus has formed among public health experts to continue current measures until the epidemic curve bends significantly downward and the stress on health care is alleviated, followed by a phased-in approach guarded by, in effect, a public health army. That army would be fighting a guerrilla war, armed with tests, tracing, isolation and quarantine to search and destroy inevitable flare-ups.

This approach has worked around the world. It will work here. Covid-19 would continue to spread, but the cases would be in manageable numbers. We would see not so much distinct waves as continuous, undulating swells, broken by occasional angry whitecaps.

But if we do not manage our public health response well for instance, allowing a widespread lifting of restrictions too quickly we could generate a storm surge that washes away everything gained so far by so much sacrifice. That seems to be what too many politicians seem willing to risk.

Those politicians should consider this: In 1918, San Antonio was one of the slowest cities to close, yet one of the quickest to reopen. As a consequence, more than half of the citys population got sick, and almost every household had at least one person ill. And Covid-19 is more contagious than influenza.

Its past time we start doing things the right way. We still lack the testing capacity and anything approaching the necessary public health army. Its past time we start building both.

John M. Barry is the author of The Great Influenza: The Story of the Deadliest Pandemic in History and a professor at the Tulane University School of Public Health and Tropical Medicine.

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Will Warm Weather Slow Coronavirus? - The New York Times

On April 10, a pastor appeared on Carlsons show to accuse the city government of Greenville, Mississippi, of anti-Christian harassment because it did not allow drive-in church services.

Senator Rand Paul on April 10 tweeted an attack on Kentuckys warning that people who attended large services on Easter could face tickets and quarantine orders: Taking license plates at church? Quarantining someone for being Christian on Easter Sunday? Someone needs to take a step back here.

The Fox News host Jeanine Pirro on April 15 praised Michigan protesters who resisted an unnamed them who want to keep us away from churches and synagogues.

On April 18, Donald Trump retweeted this complaint about Easter restrictions:

Lets see if authorities enforce the social-distancing orders for mosques during Ramadan (April 23May 23) like they did churches during Easter.

At a press conference that day, Trump was invited to explain himself, and he did:

I am somebody that believes in faith. And it matters not what your faith is, but our politicians seem to treat different faiths very differently, and they seem to think, and I dont know what happened with our country, but the Christian faith is treated much differently than it was, and I think its treated very unfairly.

He added: They go after Christian churches, but they dont tend to go after mosques.

All of this might seem performative victimhood as usual, but on April 27, Attorney General William Barr issued a directive to the 93 U.S. attorneys and the civil-rights division of the Department of Justice to be on the lookout for state regulations that discriminate against religious institutions and religious believers.

The sense of persecution that pervades conservative talk has jumped to sway federal law enforcement.

It needs to be stressed at the outset that almost all faith groups in the United States have voluntarily and responsibly complied with public-health restrictions. Two dozen Muslim groups signed a statement on the eve of Ramadan urging Muslims to celebrate the holy month in rituals at home, not in mosques or Islamic centers. The Church of Jesus Christ of Latter-day Saints suspended all services worldwide on March 12. Catholic churches likewise suspended public Mass. Cellphone records confirm that the large majority of Christian worshippers marked Easter at home.

But human nature being what it is, people will predictably resist even sensible rules for their health. Hundreds of New Yorkers crowded together to watch a hospital ship dock, which would seem about the ultimate in self-defeating behavior. Police in many states have issued warnings and fines to enforce social distancing. People have been arrested for hanging out on Brooklyn street corners in too large numbers. People have been fined for gathering in large groups on Los Angeles beaches. (California Governor Gavin Newsom is warning of even stricter enforcement if rules are broken over this warm weekend.) And people have faced sanctions, including fines and arrest, for defying rules against religious assemblies.

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Trump Brings Religion Into the Coronavirus Culture War - The Atlantic